The curse of comparing


Ever since numbers crept into the management of diabetes, all of us have fallen prey to our desire to compare and contrast. Searching for differences and variances in any situation are simply part of being a human being. That would not be much of a problem if we didn’t take the next step: to judge. Whether it’s the A1C, BG meter readings or sensor patterns, our ability to compare and contrast can easily slide down a dark path to judgment, shaming, and even condemnation. Social media allows for easier expression of these emotions.

I’ve shared hemoglobin A1C data with tens of thousands of patients and families over the last 35 years. At first, the value was not well understood or appreciated. But over time it became the centerpiece of the entire diabetes clinic visit and where it remains now for most persons with diabetes and/or their parents.

Why do we dwell so much on this number? In part because we’ve been taught that it can estimate the long term risk for certain problems associated with diabetes. These problems are scary to most of us and we fear that we (or our children with diabetes) might develop them some day if we don’t change our act. The medical system is also designed to use this information to instruct (‘program’ might be a better word) us on the consequences of our actions.

I find it paradoxical that I had NO A1C checks as a child. My first A1C as an adult at age 25 was over 10% after 15 years of diabetes. My parents did not have to carry that burden of numbers. A fact that I am actually thankful for.

The method of assessing diabetes control was based on colors. A urine dipstick or the color of a solution boiled in a test tube provided a rough estimate of the amount of sugar spilling over into my urine.

In pediatrics, parents are the most concerned about the A1C results. The tension in the room can be palpable when I’m about to share this information with them from our ‘point of care’ A1C device. Once the result is revealed there are several common responses that follow.

One is casual. Maybe even a bit nonchalant. This measured response could be from understanding that this number is just part of striving to live life well with diabetes. In other words, the A1C is not the “end all and be all”, just one piece of the puzzle of control.

In most cases the parent asks what the prior result was and promptly proclaims a specific judgment statement such as “I was afraid of that”, or looks at the child/teen and says “You went up” (never mind the “up” might be only a tenth of a point from the prior result). The statement might even be accompanied by a direct stare at the child or teen. It’s the visual version of “I told you so”.